No provider wants their patients to feel nauseous in recovery, but the importance of preventing one of surgery’s most dreaded complications seems a bit higher when children are involved — especially because kids are twice as likely as adults to experience PONV. “The etiology of pediatric PONV is complex,” says Robert W. Simon, DNP, MS, CRNA, CHSE, CNE, chief CRNA at Huntington Valley (Pa.) Anesthesia Associates. “Some studies point to the age of the patient and immature receptor development as a potential cause, where other reports suggest the type of surgery and anesthesia play the biggest role.” The rate of PONV in children ranges from 42% in low-risk patients to as high as 80% in high-risk patients, and PONV is the fourth most common cause of unexpected hospital admissions in pediatric surgical patients, notes a paper Dr. Simon authored in AANA Journal.
Although there is no consensus as to why pediatric patients are at increased risk of PONV, there are several factors that could play a role, according to Sarah Kukura, CRNA, a nurse anesthetist at Nationwide Children’s Hospital in Columbus, Ohio. She says the lack of a consistent screening method for PONV in children continues to be an issue. Additionally, children may not be able to communicate certain factors that put them at risk.
“For example, a young child might experience motion sickness but not be aware of what they’re experiencing or be able to share that information with providers,” says Ms. Kukura. “As a result, providers could miss risk factors that likely wouldn’t be missed in adults. Children who are inadequately screened for PONV may end up getting inadequate prophylaxis intraoperatively and therefore have an increased likelihood of suffering the complication.”
Efforts to prevent PONV in children extend beyond the recovery room, according to Ms. Kukura. “In addition to the emotional impact, PONV can result in prolonged postoperative stays and unplanned hospital admissions,” she says. “PONV that occurs after major surgery — craniotomy and spinal fusion, for example — has physiologic effects that can be very detrimental, such as increased intracranial pressure and wound dehiscence. Aside from these being very unfortunate outcomes for pediatric patients, PONV events can also have very real effects on parents, who could incur higher medical bills and may end up needing to take time off from work to care for their children.”
There’s no arguing the importance of lowering the risk of PONV in pediatric patients, but prevention is easier said than done.